Gov. Charlie Baker also announced a new partnership among the state's teaching programs for nurses and physicians assistants to teach medical practitioners about safe prescribing strategies for prescription drugs.
Massachusetts state government rolled out a new version of its prescription monitoring program on Monday, which will be easier for doctors to use and will allow data sharing between states.
Gov. Charlie Baker also on Monday announced a new partnership among the state's teaching programs for nurses and physician assistants and with community health centers to teach medical practitioners about safe prescribing strategies for prescription drugs.
"I do believe at this point we are way ahead of where the vast majority of other states are with respect to creating this kind of collaboration, this relationship around core competencies and core curriculum around opioid therapy and addiction management," Baker said.
The new prescription monitoring program is a revamped version of an old program, with easier-to-use technology. State officials say the old version was difficult for doctors to use, so few doctors used it.
The prescription monitoring program collects information on when a patient is prescribed a drug that has the potential for abuse or addiction -- such as narcotics, stimulants and sedatives. The program allows a doctor to log on and see a patient's prescribing history, in order to avoid over-prescribing. The data is used to determine prescribing trends and to provide information to regulatory and law enforcement agencies when necessary.
New rules go into effect Oct. 15 that require doctors to check the prescription monitoring program any time they prescribe a Schedule II or III drug, which are the most addictive classes of opioids. Until now, doctors only had to check the database the first time they prescribed a Schedule II or III drug to a patient.
Secretary of Health and Human Services Marylou Sudders said the state has seen "an uptick every day" in doctors signing up for the program. On Aug. 12, there were 16,100 prescribers registered to use the site. On Aug. 22, there were 31,909.
According to Sudders, 63 percent of prescribers who have prescribed an opioid in the last six months are now registered with the prescription monitoring program.
"The reality is many prescribers will probably not register until they need to write a prescription," Sudders said.
The new program lets doctors in Massachusetts access data from other states -- by the end of the month, Vermont, Rhode Island, Connecticut and New York, with other states expected to join later. For the first time, the system syncs with electronic medical records, and it allows doctors to designate delegates to use the system on their behalf.
State officials say it should take just three to five minutes for a doctor to register with the system, and uploading the data takes just seconds. "It's an efficient, quick system that can be incorporated into electronic health records systems within hospitals and clinics and has this interstate interoperability as well," said Public Health Commissioner Monica Bharel.
Bharel said doctors already receive emails when a patient shows concerning behavior, and this will continue in a more efficient way. The data will also be easier to aggregate into reports, so that a doctor can find out how their prescribing practices match up against those of other doctors. Bharel said the state will make that information available to doctors to incorporate into their clinical practice.
Bharel said it is "too early to say" if the information will be used to help enforcement agencies target physicians who are dispensing medicine improperly.
Massachusetts has spent $6 million on the technology upgrades, according to the Massachusetts Medical Society.
"Substantial resources have been invested to improve the system, to make it easier for physicians to use and to access more information more quickly," said James Gessner, president of the Massachusetts Medical Society. "It is now incumbent on physicians and all prescribers to participate."
Separately, the new initiative involving the state's nine physician assistant programs and 16 nursing schools mirrors what the Baker administration already did with Massachusetts' medical and dental schools. The state brings together the schools to develop a set of core principles around opioid prescribing practices, which are then incorporated into their curriculum.
For the nurses, for example, the curriculum will include instructions about screening for, preventing and treating drug addiction. Nurses will be taught how to evaluate a patient's pain and risk for substance abuse and how to identify and provide information to patients about both opioid and non-opioid treatments for pain. They will be taught to recognize symptoms of substance abuse and refer patients to specialists, to use the anti-overdose drug naloxone and to develop effective ways to treat patients for substance abuse without stigma.
"It really is important to train our new practitioners, whether it's in Amherst, Boston, Springfield or all across the state," said Stephen Cavanagh, dean of the School of Nursing at the University of Massachusetts Amherst. "It really is a major problem you have to deal with, and certainly training the next generation of both teachers and practitioners is essential."
James Hunt, president and CEO of the Massachusetts League of Community Health Centers, said the state's 50 community health centers will also incorporate the new standards into an 18-month curriculum being launched this September to teach current doctors and nurses at the health clinics better prescribing practices.
The most recent data from the Massachusetts Department of Public Health indicates that although the number of opioids prescribed in Massachusetts is dropping, the number of drug overdose deaths continues to rise. This is due in large part to the growing use of fentanyl, a type of painkiller used in surgery that is increasingly sold on the streets and being mixed with heroin and cocaine -- which can be lethal.
The Massachusetts Legislature last year passed a law making fentanyl trafficking a felony, but Baker said "there's a lot of work that could be and should be done" by law enforcement in Massachusetts and across state lines to prevent fentanyl trafficking.